Mental illness sexual stigma: Implications for health and recovery.

Abstract

Objective Among people in psychiatric care worldwide, the majority is sexually active, and sharply elevated rates of HIV infection compared to the general population have been shown. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care. Method 641 sexually active adults attending eight public outpatient psychiatric clinics in Rio de Janeiro were interviewed for psychiatric diagnosis and stigma experiences. Stigma mechanisms well established in the literature but not previously examined in relation to sexuality were measured with the Mental Illness Sex Stigma Questionnaire, a 27-item interview about stigma in sexual situations and activities. Results Experiences of stigma were reported by a majority of participants for 48% of questionnaire items. Most people reported supportive attitudes toward their sexuality from providers and family members. Those with severe mental illness diagnoses showed greater stigma on Individual Discrimination and Structural Stigma mechanisms than those with non-severe mental illness diagnoses, while there was no difference on the Social Psychological Processes (internalized stigma) mechanism. Regardless of diagnosis or gender, a majority of participants devalued themselves as sexual partners. Conclusions and Implications for Practice Adults in psychiatric outpatient care frequently reported stigma experiences related to aspects of their sexual lives. From the perspectives of both HIV prevention and recovery from mental illness, examining the consequences of stigma in the sexual lives of people in psychiatric care and improving their measurement would have wide applicability.

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